Thursday, April 11, 2013

Why depend on Big Pharma? And work, and fun, and decisions, and the proverbial long term

A few weeks back I was telling I-HEARD-YOU about not splitting posts, and here I find myself guilty for the same. But I think it is fine, since I got some new ideas after publishing the previous post.

To read further, make sure that you know about the Novartis issue in India. I would prefer if you could read the post I wrote a few days back, but it is not required. Here is another post on the issue, more like an editorial.

Before I start the post, remember that there are two ways to hold your right ear. The first is to bring your right hand up and hold the damn ear (simple). The other is to take your left hand across and use it to hold your right ear (somewhat complex). Believe me when I say that I am writing this post according to the second way.

Customary sex/hierarchy/work/fun joke

If there is one thing I learnt from noticing (only noticing, not listening or reading etc.) the Presidential debates in US, it is that you should open with a joke when starting some kind of presentation or writing. So, here goes:
An Indian Army Colonel is dining with a Major and a Lieutenant. The Colonel purposes: "I think sex is 20% fun and 80% work." The Major says: "No sir, I think you are mistaken. Is is actually 50-50." The Lieutenant chips in: "Sirs, in my experience, it should be 80% fun and 20% work." 
Just then a Sahayak comes around the room. The Colonel asks him the same question. His answer: "Sirs, it is 100% fun and no work. None at all." 
Other three (somewhat surprised): "How can you say this? What is your logic?" 
Sahayak: "Sirs, if there was even an iota of work in it, you guys would have me doing it in place of your honorable selves!"
I do not remember where I read it from, but it is a great joke. By the way, as of April, 2013, the sahayak system is a system in the Indian Army under which trained non-commissioned soldiers are made to do the personal work of seniors. (Sahayak: orderly, from British Army.) The funny thing about this system is that all the armies of the world have abolished this system, including even the Pakistan Army a few years back. Kudos, Pak Army! In the meantime, our Indian Army has the distinction of being the only Army in the world to still follow this tradition.

From what my Sainik School friends tell me, people in the Army are kind of serious when it comes to traditions. I thought of another word in place of serious, but there is only so much profanity I can handle in a blog post I am writing, especially when I live under the illusion that maybe someday, I will be able to persuade my parents to come and read it. They made me read to them the SSC interview post with interest, the rest of the blog, not even a cursory look :-)

What was that all about?

First some groundwork.

We all work in life. For the purpose of this post, even slacking/not-working is work, like zero work or something.

At individual as well as organisational levels, people have two natures with  respect to work. Some people like to take initiative and decide what to work on. Others like to be told what to do, whether because of their lack of initiative or plain old laziness. For the most part, I belong to the second category :-)

Again at individual and organisational levels, we do not exactly belong to one of the two natures. This is because it is not possible to define a fine line between the two.

How we think or act in a situation, whether we stand back or bite the bullet depends on a lot of things in addition to our nature, like previous experience and prejudices, the gravity of the situation and our mood at the time.

Similarly on an organisational level, the same things matter in almost the same way. Some organisations take risks and succeed once in many tries, some others just don't take as much risks as they can, settling for less but sure returns every time.

I cannot stress enough the importance of the thing I called prejudice that can be considered as a factor in a person or organisation's short-term or long-term decisions. It is something that comes from the group, demographic, area or industry or some other unifying/opposing factor that defines a person or an organisation. For individuals, it will look like I am creating stereotypes, but it is very easy to see this for organisations.

Suppose that a person swears a lot. This person will not think badly of some other person, who swears as much or more than him/herself. But someone who does not swear, might take offense to another person swearing at the top of their voice. Here, we are talking about the group of people who swear a lot, and belonging or not belonging to that group might be a major factor when you try to judge someone who swears. (I personally swear a lot, mostly in Hindi/Punjabi, but am fighting it currently and hopefully will get over it in some time)

For private companies, it is normally about the industry they belong to and the target group, or customers/clients. For example, Novartis (a Swiss company) and Bayer (a German company), both a part of what we call Big Pharma, have a similar stand on most issues, like pricing and patents etc., but Cipla and Ranbaxy are Indian companies that have a similar stand on pricing and patents, but one different to Novartis and Bayer etc. For governments, you will see that the considerations are mostly of the politics and business-approach kind. North Korea is near to China/Russia and South Korea is near to US/Europeans, because of left and right-wing governing ideologies, respectively. (My personal view, as of April, 2013, is that there are only two kinds of governing ideologies: wings and center. You see, both left and right wings try to focus on providing all power to a few people while making others dependent on their whims and fancies, groups called the politburo and the capitalists, respectively. Again, as of April, 2013, as you might have noticed, I am the king of sweeping generalisations)

That is fine, but what does it have to do with the pharmaceutical patents issue?

Something about decisions that I probably should have mentioned earlier, but did not in order to keep the flow of nature, is that these are broadly of two kinds: short and long term decisions. A morally and logically consistent person or organisation will try to keep their short term goals in sync with their long term goals, unless it is an emergency or otherwise unusual situation, like, you know, a few months before elections.

And as with everything, logical/moral consistency between short and long term goals again depends on things like prejudice, gravity of the situation and mood or mental state (and a few other factors I cannot think of). For example, you are likely to get your weird-noise-making vehicle checked next Sunday (short term) so that you can drive it comfortably for many weeks to come((relatively) long term). But sometimes we just keep eating like animals (short term), even when we know we will have a hard time losing the excess weight (long term).

The million-tablet question

Since we had work and fun in the beginning of this post, now it is actual decision time.

What to do? Should I/we even be doing something? When should I/we start? To what limit am/are I/we to proceed? Questions, questions. Where are the decisions answers?

A big question is, should I/we even start? This one is normally simple. You feel hungry. Should I eat? Yes. Your company is making losses. Should we cut losses? Hell yes! Your government is not exactly the most liked one. Should we be doing something about our public image? Duh!

An even bigger, rather biggest, but more ambiguous question is, should I/we do it myself/ourselves, or let someone do it for me/us?

In the software industry, Joel Spolsky takes care of it in a great post: In Defense of Not-Invented-Here Syndrome. Quoting him:

The best advice I can offer:
   If it's a core business function -- do it yourself, no matter what.
Pick your core business competencies and goals, and do those in house. If you're a software company, writing excellent code is how you're going to succeed. Go ahead and outsource the company cafeteria and the CD-ROM duplication. If you're a pharmaceutical company, write software for drug research, but don't write your own accounting package. If you're a web accounting service, write your own accounting package, but don't try to create your own magazine ads. If you have customers, never outsource customer service.

The million tablet answer

Master Oogway's short answer: There are no accidents answers.

Long (and not really an) answer:  Lets consider two kinds of organisations: private ones and governments. What is the difference between the two? 

Both exist to serve people. Both want to stay the longest. Both exist according to the people's pleasure (Not exactly true for governments, but remember, companies need to be thrown off like authoritarian regimes too. What am I trying do with Novartis (albeit unsuccessfully) right now?)

The difference is in terms of their target. No matter what they tell you, companies' primary target is profits mostly, and secondary target is people's happiness (there are non-profits/NGOs etc. too, but let us ignore them for this post). Government's primary target, on the other hand is people's happiness (responsibility towards people), and the secondary target is revenues.

I know both the targets are the same if we forget which is primary and which is secondary. So, here is an example. Going by their prices, Novartis want money. They sell medicines for that. But if an epidemic comes up, will Novartis consider selling their drugs cheaply? I think not. Because some parts of Asia and most parts of Africa are in a perpetual state of epidemic, and Novartis have not done anything for anyone there. But this does not absolve the governments of these nations from their responsibility of helping their people. And therefore the governments will do what they can, hopefully. What it means, in the end is that when they need to change their priorities, different people/organisations are more likely to ignore their secondary targets than primary.

See, two birds with one arrow: explained my point and made fun of Novartis while doing it!

So, what I am saying is that it is upto the governments to decide what they should do and what not, and that by deciding to not create medicines themselves, the governments are in a way outsourcing this by accident. According to Joel's logic and my (admittedly sparse) common sense, I think that it should be upto the governments to research and develop medicines etc. And I am not talking of silly NIPER thingies. Just making institutions does not do the trick, what does it is actually doing it.

A lot of people would like to point out Left wing countries that have public health as one of their core things, and no private health infrastructure etc., and still have bad overall health. The reason is that these countries too take public health as seriously as we Indians take it. Also, when a country like North Korea has problems feeding its people, do you really think they would invest properly in the people's health?

I do not know about the rest of the world, and for a while forget about competing with GPS, GLONASS and Beidou. When a country like India can invest in IRNSS, spending I don't know how much, then I think it should not be a problem for our government to invest in medicine as much as in space programs. I know we have companies like Cipla and Sun and Ranbaxy and many more, but still, due to any reason, what if these companies try to increase their rates? Obviously, these companies did not enter the market for charity.

Is it over yet?

The point I am trying to make here is not just about Novartis. It is about our governments and the way these governments make decisions.

What is the Indian government doing for protecting farmers against Biotech seeds? For our tribals, whose natural resources are being mined and used by foreigners. I am as much a foreigner in a tribal area as an Indian or foreign mining/timber company. What kind of an example is the government setting by not helping Ashok Khemka?

So, in conclusion, it is probably most definitely a good idea to create cheap heart disease hospitals, but not a good idea at all if the the government is using people's money to build a new spa for rich people.

Feeling guilty

I spent the last 4 hours writing this post, and on weekends I go to the Rebol room and tell the great people there that I did not do any rebol over the week. Kind of sucks.

I wrote this post, with almost 75-80% part as the introduction, but am gonna sleep just when I came to the actual thing.

One thing I do not feel guilty about is writing about economics without knowing anything about it. There was an economics class in college, but we took it more like an aerodynamics or aeronautical class, making paper planes and all :-)

And I did not even talk about the proverbial long term, mostly since I don't know what the hell it is. Especially when everybody thinks in terms of 5 years!


  1. Seriously, it was such a long post, I myself don't know where it started. But, anyways, we do get it- Novartis and other big pharmaceutical companies are the bad ass players in the market. They should be chased away from this hinterland. But I have a question- you have local handwoven bags/purse which you use everyday and so do other mango people. Then there is a Louis Vuitton bag which would probably be purchased by SRK or even by you for your girlfriend. Now, if LV is selling its bag or even rolex is selling its watch at exorbitant prices, aren't they are free to do so? You can't take out mercedes out of india just because they didn't develop the cheapest car- nano.It's not their job to hand out a car to every indian ( regarding your epidemic point). We don't have even the basic transport system in rural areas. But is BMW or mercedes or audi have any moral obligation to improve it? Hell no. It will degenerate their brand value in addition. Would you relate to rolex if it started selling its watches at 4$-5$? With time the craze for rolex would eventually fade away! But we are talking about drugs here. If someone feels Novartis is a safer option, he is free to choose that. Atleast he has an option over pirated drugs! It is the same case like you go for treatment in Max hospitals or go to safdarjung hospital for the same treatment. The choice is yours. You will get cured at both the places but i would prefer Max hospital(max is a 5 star hospital BTW) And here too max hospital is certainly not liable to provide free medication in case of an epidemic. It can do out of charity but certainly not under any kind of pressure. The companies work to earn. The governments work because of elections. There is no point of happiness in anything. the governments already have their own faculties for research e.g DIPSAR- DU. Other facilities at various places are also present. And they do invent new drugs. But neither they advertise it nor do they have any marketing retailer for it. Left with no choice they outsource the manufacturing unit. And then the private company sells the drug under its own banner. Govt. is very clever to not to invest in retail. You yourself said it that govt. works for 5 year goals. Do you think you can create a market for your drug in such a short time? And even if you start, would the next party in power continue with your project? These uncertainties force the govt. to work only for short term goals. ANd regarding bio-tech seeds- we do have stringent laws to prevent bio-piracy. The most recent example that came in highlight was about an year or two ago when you heard about Bt-crops in the newspapers. If you had followed the story closely you would have realised that govt. is spending a large chunk of its revenue on inventing and testing new pest-resistant Bt-seeds. Last but not the least, we mango people should enjoy mangoes this mango season and let NGOs worry about this. As far as I am concerned, I am more pissed off at the muslims and their mosques. At 4 am in the morning the bastards start singing on their loudspeakers!

  2. First of all, I am kind of sure there is some mosque near to your home, where loud sacred music is played in the mornings. I do not think it is reason enough to come so strongly against our Muslim brothers. I live at Shivalik City, near Kharar which is near Mohali, and almost everyday I can hear loud religious music, either at some Temple or Gurudwara or from some Hindu or Sikh household.

    Apart from this, as far as the bags and mercedes/nano topics go, I am sorry to have not explained it properly. Don't let me or anyone else tell you about sending any company out of India, no matter how bad/expensive. Because these generate jobs here, contribute to our national income and mostly serve us in some respect. Taking the example of bags, as long as it is about SRK or my (imaginary) girlfriend, no doubt it is not a problem in spending. Maybe I am not too sure on my part, I can't spend too much, but SRK, definitely! But when school children in rural areas have to carry heavy books on their heads, then neither LV nor some Indian bag company would be able to help them. In that case, I think the government should chip in.

    Another example, again stolen from you, is that if you have the money, then sure, there is nothing as good as Max hospital. But Safdarjang has its advantages for the poor people. You kind of helped my cause by providing this example. I never said about just sending away the Big Pharmaceuticals, what I said (albeit not in the exact words) is that the government must do something in pharma sector. This becomes even more important when we think the coming (or some say already arrived) time of chemical and biological warfare. (I think wartime rape is also a kind of biological warfare tactic.) Sure, there are lots of governmental pharma institutions, but what is the advantage when we are letting private companies sell the final product? I think the government is not being true to the nation when it does not market its drugs enough. I am sure that at some stage, government money, in howsoever small amounts is being used to 'tell' the general public about using set-top boxes instead of cables, but I am really confused that except the polio campaign, the government is not publicizing its medicines enough. Also, I don't know why private pharmas are not doing anything for polio, so the government has to take care of it. It would be interesting to know. (By the way, I did not know about the government giving selling rights for their R&D-ed drugs to private companies, thanks for sharing, and keep sharing.) :-)

    At a certain scale of things, it becomes difficult to provide facilities at same/similar margins. That is where private companies either quit or start creating artificial scarcity. And this is where the government has to step in. Not really sure how I would relate it to the topic at hand, but the Delhi metro is a very good example of the government coming in to salvage a bad traffic situation.

    Don't know what to say for governments changing after every 5 years. We do have directive principles and the other things in the constitution and all. Let us hope these continue as guiding lines for our leadership. Don't remember much of it, read it in school, about 10 years back.

    Really good comment, by the way. Really made me go on the back foot!

  3. Well,I couldn't understand the first part of your comment but in bits and pieces from what I have gathered you are trying to say that it is the government's job to provide basic medical and healthcare facilities. Hell, yes it is theirs. And they are doing their bit but you know how bureaucratic system works. Slow, uneffective and just pathetic. To give you some heads up, the government is advertising various health schemes- Nirodh, a popular one for safe sex, NACO, the organisaton for AIDS, Rural service agreements for going to be doctors, apart from the free health check ups in rural areas. And don't forget CGHS scheme. Do you go to a psychiatrist when you are in trouble for depression or something similar? No. And I must say this bluntly, that it is the attitude of people that needs to be changed and the services will change thereafter. Only when there is demand, there is a service. FOR example 3G. The world is now planning to move on to 5G but India was still on 2G. And the 3G mobile phone market boomed in just a span of two years. There is the demand. And see now we even have 4G in some cities. Similarly, in villages you don't seek a doctor's help at first go. People there wait for the things to get out of hand. Even then in some cases they do not visit a doctor at all. So, is it the government's fault if people are being mindless? No. The government is doing its bit and we expect it to do it more diligently.

    Secondly, the government is also doing a great job on controlling the prices of some essential drugs. You already stated this fact previously.

    But wait, why the hell are we debating on this topic? It leads us to no end, does it? If we gotta debate, let us debate on FDI which will also include this topic to some extent.

    And to every other religiously open person out there- I am not a racist neither I hate muslims. I hate every other fool out there who interferes in some way in my life. Here, it is by the way of noise. And I don't even advertise my community's way of propanganda by the way of loud bhajans and kirtans! It's disgusting, no it's a torture for even god when fat aunties in their cracked voices compete to become the loudest. I just keep wondering at this defect of nature when it made some humans mindless!
    And sure you are religious. But do not let religion get mixed up with the laws of society. I gave you wiki link earlier. I think you did not read it. I still oppose all the bastards and dickheads who play loud music for any purpose be it religion or their stupid new year vendetta!Especially at 4 am in the mornings and 1 pm at night!
    To make this comment longer than this post I should add another thing- in the times when there were no loudspeakers such bhajans and kirtans and calls for namaaz were not so pompous and subtle and beautiful. With loudspeakers it is just really a torture.

  4. I agree with all you say, especially with the long-post/long-comments part. I think I wrote a really long post, and then you and me contributed 3 posts in the form of comments. :-)

    Hope to read all sort of things from your side in May.